The recent focus on Hospital-at-Home is cause for optimism

Remember the term, ‘Patient Centered Medical Home’? This was a hot topic for us 10 to 15 years ago, before the big explosion of EHR implementations that came as a result of the Affordable Care Act and Meaningful Use. I can recall being a more energized version of myself (read: a little younger, a little less experienced, and maybe even a little less – should I say – wearied?). That was me before years long projects; millions and millions in budget; and hundreds of people to coordinate, accommodate, please and wrangle when I had a lot less gray hair. It’s amazing how a few big EHR projects can make 10 or 15 years feel like a lifetime.

The concept of the Patient Centered Medical Home was so exciting to me, a young healthcare IT groupie, someone who truly believed (and still does) that technology innovations were the key to improved patient outcomes. This was so long ago in the yester years of healthcare IT, when most people were just starting to hear about EMRs (the favored historical term). See what I did there? In the 16th century, we used the terms thou and thee. Now we use you, y’all, peeps, homies, and team if you’re more professionally inclined. It’s basically the same thing. EMRs to EHRs. Healthcare IT to Digital Transformation. You catch my drift. Back to the point, I’ve recently been thinking about the resurgence of the patient-centered medical home in the context of current popular healthcare IT discussion, specifically the latest: hospital at home.

The five key features of the Patient Centered Medical Home are Patient-Centered Care (putting the patient first … wait, what kind of innovative thinking was that?), Coordination (providers talk to each other!), Accessibility (easy to find and available appointments), Quality and Safety, and Comprehensive.

The five key features of the Patient Centered Medical Home are Patient-Centered Care, Coordination, Accessibility, Quality and Safety, and Comprehensive.

So where are we now? Have we begun to meet the five key functions of the Patient Centered Medical Home? In the last 15 years, there have been a number of amazing and innovative technologies that are beginning to change healthcare for patients. We have all sorts of wearables, we have digital thermometers that can send data straight to the doctor’s office, we even have belts that monitor your vitals!

When I was at CES in January of 2020, one of the hot pieces of healthcare tech was a sleep sack for infants to help prevent SIDS. The fabric the sack was made from had computerized sensors that could send the parents a notification when it tracked changes in the baby’s breathing patterns. Talk about innovation! When my kids were born 20 years ago, that kind of tech would have saved me a lot of sleepless nights. Yet, as a healthcare industry as a whole, we still struggle to meet the five basic principles of an improved care model from 15 years ago. Why is that? And what is the innovation in the pipeline over the next few years that will drive real change?

I truly believe, and I know many of my technology colleagues agree, that a big part of the problem right now is policy. Not just public policy, but private policy. (And frankly, I think the lack of innovation in private policy is a direct result of poor change management..) Private healthcare providers, which make up approximately 80% of the healthcare in our country, set their own policy. There is real incentive to keep a patient’s comprehensive care within the walls of their own organization. That works great when the healthcare system provides access to all healthcare services to all its patients, but most healthcare providers aren’t big enough to provide those comprehensive services.

We’ve all experienced this. You go to your primary care provider offices on a hospital campus – she asks you to have your annual mammogram, so you make an appointment with the provider she referred you to, who she even sent the order for! A few weeks later you show up to your mammogram, in an office or clinic at the bottom of your PCP’s hospital campus. But, and you probably don’t know this as the average patient, it’s a completely different organization – not owned by the same healthcare provider your PCP is owned by.

Thank goodness at least the medical records are integrated in a situation like this, so at the very least when you open up your patient portal, it feels seamless. But what happens if you have, say, a car accident? You’re discharged from the hospital, maybe to a rehabilitative care center, then outpatient physical therapy, then maybe a chiropractor. Everything starts to break down now. And yes, in most cases all these different providers can cobble together some data sharing strategy to seem like an integrated delivery system, but the patient doesn’t usually experience that.

During my research, I started on the latest and greatest in the concept of Patient Centered Medical Home, which quickly brought me to the hot news surrounding Hospital at Home. The two primary headlines: Kaiser and Mayo Clinic announced a $100M joint investment in Boston-based Medically Home, and Huma, a patient-centered hospital at home technology company, raised $130M in a Series 7 investment round to total $200M.

Let’s focus on Medically Home, a Boston-based firm that gives providers the ability to allow home-based care for high-acuity or complex patients. According to the press release by Kaiser, “Medically Home is a technology-enabled services company that provides the clinical intellectual property, technology platform, and coordination of acute rapid-response services that allow medical providers to safely shift advanced medical care from hospitals to patients’ homes. Through enabling its customer partners to create superior experiences and outcomes for patients, their families, and healthcare stakeholders, Medically Home is leading the charge in the innovation of healthcare delivery.” (Kaiser Permanente, n.d.)

The product is a combination of technology and service, meaning Medically Home uses their proprietary software to provide virtual access to home bound patients with complex acute cases. Medically Home runs the telehealth software, integrates its data with EHRs, and uses technology to bring providers into the home. They use what they call a medical command center that is staffed 24/7 by a variety of providers that are overseeing the patients. In addition, they leverage a network of first responders, float pool nurses and other providers to support the in-home care part of the program.

When you think about the five components of Patient Center Medical Home – where does Medically Home score? Is it patient-centered? Absolutely. Is it accessible? By definition, hospital-at-home is extremely accessible to the patients in the markets where the service is available. Is it comprehensive and coordinated? In the case of Kaiser and Mayo Clinic, particularly Kaiser, whose patients are both members and patients, and primarily stay within the system’s “walls,” the hospital-at-home model should be highly coordinated and comprehensive. And finally, what about quality and safety? According to Medically Home and Kaiser, home based acute care has been shown to be safe, is a patient satisfier, and reduces readmissions.

This week I had the opportunity to have dinner with the Chief Medical Officer, the president of one of the hospitals, and the Chief Physician Champion for one of our clients. We talked a bit about the Hospital at Home concept, and whether this was something they were energized by and thinking about for the future of their patients. What they shared with me re-energized my optimism about how far we’ve come in the last 15 years.

While we don’t necessarily refer to the features of healthcare we now take for granted – easily scheduled appointments in our patient portals, virtual visits, integrated health records, single patient statements, our medical records on our phones! – as a single Patient Centered Medical Home model, plenty of the five key concepts exist in most large healthcare delivery systems today.

And my provider friends brought up a very good point. When they were in residency a decade and more ago, healthcare looked very different than it does today. COVID aside, the ICU patients of yesterday would rarely become so ill, they would be admitted to the ICUs of today. They are now either cared for in non-ICU units (which of course is much better for the patient, and as we all know these days, once a patient is intubated, their chances of survival start to decrease significantly) or they are discharged and sent home to recover. The ICU patients of today, however, would not have been alive just 10 years ago. In other words, they truly believe (and I agree!) that medicine is progressing and we are extending the lives of patients.

So, imagine what healthcare will look like 10 years from now… Imagine it with features of the Hospital at Home for patients who are very ill. They will have the technology and the same level of care available right from their own homes, surrounded by their families, in places where they are most comfortable, and in environments that provide a much higher quality of care.

The beleaguered me of many, many EHRs; the person sent all over a hospital campus but to an undisclosed variety of providers, that version of me is starting to be optimistic again. Here we have progress. Here we have an opportunity to truly achieve the five key concepts of improved care. It’s at our fingertips, we just need for it to live up to its promise.

by Shannan Epps, CEO & Founder